Am I An Alcoholic? How To Tell If You're Drinking Too Much

Writer Anna Davies was that girl. The one who wakes up in strange places, with strange men—and with only a vague recollection of the night before. But the way she got everything under control may surprise you.

There's a list I keep on my hard drive: "Things I've regretted doing while drunk." Every entry causes me to cringe; some make me cry. I've broken five iPhones. Irrevocably damaged two "best" friendships. The worst: One time, when I was 24, I woke up from a blackout naked and in an unfamiliar van. A man I didn't know was lying on top of me.

The therapist I began seeing after that incident started asking whether I had an alcohol problem. At the time I was stressing out at work, panicking as friends began settling down, and grieving the recent deaths of my mother and grandmother. But the therapist focused on my alcohol use.

"How much did you drink?" she asked.

"Three or four vodka sodas?" I shrugged. Whatever I'd had wasn't wildly out of sync with what everyone else was drinking.

"Three or four?" she asked. "You could buy a penthouse for that money!"

No, I could not. I rarely ever paid for my drinks. Alcohol was everywhere, from first dates to work-related open-bar events. In fact, the alcohol I had purchased was gathering dust on top of my fridge.

My therapist said she couldn't continue to see me unless I joined a 12-step program.

So I left therapy.

I'll just be more careful, I told myself. But I wasn't. Over the next four years, my regrets list kept getting longer. I saw another therapist, then another, both of whom also suggested I try a 12-step program. Each time the decision was easy: Quit therapy, keep drinking.

Until a spring Friday when I was 28. I showed up drunk to a date. We made small talk and ordered a pizza. I was two slices in when he said it wasn't good. He was right, but I drunkenly lashed out at him, calling him ridiculous for complaining. I stormed away, hoping he'd follow me. He didn't.

In terms of my list, that night was minor—and that was terrifying. I went to my first 12-step meeting the next day.

"My Name Is Anna and..."

The 12-step process has been the predominant therapy for alcoholism for about 60 years, but it wasn't developed by doctors or scientists. It grew out of the practices of a religious society known as the Oxford Group, which believed that self-improvement came from prayer, meditation, and admitting your wrongs. Bill Wilson, a stockbroker struggling with alcohol addiction, popularized the concept with leaderless meetings, and in 1935 Alcoholics Anonymous was born. Its Twelve Steps are the method Wilson and others found worked best.

As the decades progressed, 12-step programs evolved to address other issues as well—overeating, gambling—and their popularity grew. Celebs like Lindsay Lohan revealed their own experiences with AA, and 12-step-inspired scenes became plot points in movies like Rachel Getting Married. Because of these glimpses into what really goes on "in the rooms," I assumed AA would be dingy and dramatic. While some stereotypes were scarily accurate—yes, it was in a church basement; yes, I did say, "My name is Anna, and I'm an alcoholic"; yes, there was weak coffee in Styrofoam cups—others weren't. For instance, the majority of the attendees weren't strung out and sad. They were confident, brilliant, and vibrant. Many, recognizing me as new, offered their phone numbers. The message was clear: Stick with us, kid; you'll be OK.

And for 67 days that summer—trust me, I counted—I was. I held hands with strangers, discussed my feelings, and prayed.

Then I slipped. It started with drinking at a friend's wedding and continued when I got home. For the next three years, I occasionally went to meetings, sometimes for several-month streaks, sometimes just once. My program sponsor didn't like the fact that I still occasionally went to bars with friends, even if I only ordered a soda. So I eventually stopped going to meetings and went back to happy hours instead. There I felt guilty after one drink, and that feeling led to an eff-it-all mentality that sent me back to the bar four, five, 10 times. Ironically, labeling myself an alcoholic actually made me stop trying to cut back on my Olivia Pope-sized glasses of red wine. What was the point? I'd have to give it all up eventually.

Then I started seeing a new therapist.

"I guess I'm an alcoholic, right?" I asked.

"Maybe," she said.

What Defines "Alcoholism"?

From the birth of AA till the 1990s, conventional wisdom held that alcoholism was a severe and progressive disease that required abstinence to manage. But around the turn of the twenty-first century, researchers found that alcohol dependence actually exists on a spectrum that runs from mild to severe. That's because they began looking at all problem drinkers instead of just those in treatment. "Someone who cannot make it through the day without drinking is very different from someone who binge-drinks at parties, who is different from someone who drinks a glass or two of wine a night," says Mary Ellen Barnes, Ph.D., president of Your Empowering Solutions, a California-based treatment program.

The most recent version of the Diagnostic and Statistical Manual of Mental Disorders—psychiatry's bible—uses the term alcohol-use disorder to describe this range. Currently a woman must exhibit at least two of 11 possible criteria—like drinking more than intended on a night out, and failing in the attempt to stop or limit drinking—within a 12-month period to be diagnosed. Drinkers who meet six or more criteria are diagnosed with "severe" alcohol-use disorder, which is what most people think of as alcoholism.

Today, more women are drinking more alcohol more frequently, according to a 2015 study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). But only 9 percent of women who drink excessively—defined as eight or more drinks a week, or four or more drinks on a single occasion—would qualify as having severe alcohol-use disorder, a recent Centers for Disease Control and Prevention study found. "Because alcoholism is a term thrown around in pop culture, people sometimes assume they're alcoholics when that's not necessarily true," says Gabrielle Glaser, author of Her Best-Kept Secret: Why Women Drink—and How They Can Regain Control. In fact, "the most common form of alcohol-use disorder is mild to moderate and doesn't involve major life disruptions like DUIs or job losses," says Mark Willenbring, M.D., founder and CEO of Alltyr Clinic in St. Paul, Minnesota, and a former division director at the NIAAA. "About 75 percent of people with alcohol-use disorder have a single episode that lasts, on average, three or four years and never comes back." For most of them recovery happens without formal treatment. It's not that treatment wouldn't have helped, but most resources target severe cases and have rigid rules like abstinence, which can discourage sufferers at the mild end of the spectrum from participating.

To be clear, most experts would prefer it if all severe drinkers at least tried swearing off alcohol. "We generally recommend that people with alcohol problems aim for abstinence," says George Koob, Ph.D., director of the NIAAA. "That's the safest thing." But, points out Dr. Willenbring, "it's important to distinguish between AA, which is an association of people supporting each other, and abstinence treatments, which are provided by professionals." Why? Because while there are 1.1 million Americans in AA at any given time, a comprehensive nationwide report showed that most people who abstain aren't being treated by medical professionals with the knowledge and skills necessary to provide a full range of effective treatments.

That's not to say AA isn't useful. People with severe addictions require abstinence, and for them AA can be "lifesaving," says Dr. Willenbring. But some experts estimate that only about 30 percent of people who've gone to AA once continue attending meetings for at least one year. (AA's public information coordinator says the organization "keeps no membership records or case histories, so we're not able to speak to claims about its effectiveness.") "When people ask me, 'Does AA work?' " says Dr. Willenbring, "I say, 'Well, it works for the people it works for.'"

To help people with mild to moderate alcohol-use disorder, experts are turning to science-driven strategies that don't depend solely on abstinence—like anti-relapse medications, counseling, and moderation management. The goal of these treatments isn't to stop drinking but "to minimize the frequency, severity, and length of any relapses," says Dr. Willenbring. "To do that we teach people how to recognize and deal with high-risk situations and how to manage recurrences of problem drinking if they happen."

Working through my own issues with alcohol required a concrete plan and lots of soul searching. My new therapist suggested I try moderation—one drink at weekend events, none during the week—as we slowly untangled my emotions. I hoped these more sober habits would make my entire life fall into place: I'd never procrastinate at work! No more fights with friends! But I still found myself doing those things—only now I couldn't blame alcohol; I had to examine the deeper anxieties that fueled these decisions. And it was tough. My therapist and I talked about how desperately I missed my mom, even though so much of our relationship had been anchored in keeping up appearances and making her happy. A few months after she died, I came across one of her journals and read "I'm worried that Anna isn't a very nice person." She was always concerned when I expressed negative opinions, so I'd learned from an early age to always make it seem like everything was fine. Alcohol, I realized, was one way I suppressed any bad feelings I had.

One technique for dealing with alcohol issues involves having patients evaluate their drinking habits by doing a cost-benefit analysis, says Carrie Wilkens, Ph.D., cofounder of The Center for Motivation and Change in New York City. "Write down how you think alcohol helps your life," she explains. "Then list how it impedes you. Ask yourself: What pulls you back to drinking even though the consequences upset you? Understanding these 'benefits' can show you what you need to change about yourself or your life in order to be less reliant on alcohol."

When I tried this exercise, I saw that in my early twenties I viewed my extreme drinking as helping more than harming me. It made me fun—and often went unnoticed, a phenomenon Barnes sees among overachieving women: "They may not be getting into fights or taking physical risks the way men do, so their problem can be harder to spot."

But as I got older, things started to shift. For one, the van incident had seriously shaken my sense of safety. My friends started settling into relationships and stopped hitting happy hours every evening. Physically and psychologically, I was no longer able to bounce back easily from a night out. And mounting anxieties in my personal life meant that when I did get drunk, I became weepy and paranoid. Fun? Not so much. I needed help.

Drinking...Within Reason

And that's one thing all experts agree on: Women like me do need help. If you're worried about your drinking, you shouldn't wait to "outgrow" your behavior. Taking action, whether it's planning for the next time you go out or getting counseling, is essential.

The latter helped me immensely. I still see a therapist, but our sessions are no longer focused on alcohol. I've started a new list: "Fun things that happened when I wasn't drunk." The more I add to it (sober sex: much better), the easier it is to turn down a second drink. I still like drinking, but I also like waking up in the morning and going to the gym, or at least flipping through my Instagram feed without regret. I haven't been drunk in two years.

Even though I never felt at home in those church basements, one tenet of the 12-step program I've found helpful is sharing my story. I want people to know I've struggled and that I have a complicated relationship with alcohol I'll always need to assess.

Example: Recently a guy invited me over. We'd had a couple of drinks on our first date, but none on the next three. As he grabbed a bottle of wine, I shook my head.

I was about to tell him I had an early morning the next day but paused, then nervously told him everything: my regrets list, my stint with sobriety, and my therapists' advice.

"So...yeah. What do you think?" I asked, my voice trailing off. Being stone-cold sober and talking with a guy about how vulnerable I felt was scary.

"I like you. All of you," he said. "And I'm glad you trusted me with this."

The best part? The next morning I actually remembered our conversation.

Anna Davies is a freelance writer and young-adult novelist living in New Jersey.